INTRODUCTIONAccurate epidemiologic estimates for dementia are lacking for American Indians, despite substantive social and health disparities.METHODSThe Strong Heart Study, a population‐based cohort of 11 American Indian tribes, conducted detailed cognitive testing and examinations over two visits approximately 7 years apart. An expert panel reviewed case materials for consensus adjudication of cognitive status (intact; mild cognitive impairment [MCI]; dementia; other impaired/not MCI) and probable etiology (Alzheimer's disease [AD], vascular bain injury [VBI], traumatic brain injury [TBI], other).RESULTSAmerican Indians aged 70–95 years had 54% cognitive impairment including 10% dementia. VBI and AD were primary etiology approximately equal proportions (>40%). Apolipoprotein (APO) Eε4 carriers were more common among those with dementia (p = 0.040). Plasma pTau, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) were higher among those with cognitive impairment, but not amyloid beta (Aβ). Cognitive intact had mean 3MSE 92.2 (SD 6.4) and mean Montreal Cognitive Assessment (MoCA) score of 21.3 (SD 3.2).DISCUSSIONThis is the first population‐based study to estimate the prevalence of vascular and Alzheimer's dementias in a population‐based study of American Indians.Highlights The Strong Heart Study is a population‐based cohort of American Indian tribes, conducted over 30+ years and three US geographic regions (Northern Plains, Southern Plains, Southwest). Our teams conducted detailed cognitive testing, neurological examination, and brain imaging over two visits approximately 7 years apart. An expert panel reviewed collected materials for consensus‐based adjudication of cognitive status (intact; MCI; dementia; other impaired/not MCI) and probable underlying etiology (AD; VBI; TBI; other). In this cohort of American Indians aged 70–95, 54% were adjudicated with cognitive impairment, including approximately 35% MCI and 10% dementia. These data expand on prior reports from studies using electronic health records, which had suggested prevalence, and incidence of dementia in American Indians to be more comparable to the majority population or non‐Hispanic White individuals, perhaps due to latent case undercounts in clinical settings. Vascular and neurodegenerative injuries were approximately equally responsible for cognitive impairment, suggesting that reduction of cardiovascular disease is needed for primary prevention. Traumatic injury was more prevalent than in other populations, and common among those in the “other/not MCI” cognitive impairment category. Mean scores for common dementia screening instruments—even among those adjudicated as unimpaired—were relatively low compared to other populations (mean unimpaired 3MSE 92.2, SD 6.4; mean unimpaired MoCA 21.3, SD 3.2), suggesting the need for cultural and environmental adaptation of common screening and evaluation instruments.

中文翻译：

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美洲印第安人痴呆和阿尔茨海默病的流行病学和患病率：来自强心研究的数据


简介 尽管美洲印第安人存在巨大的社会和健康差异，但仍缺乏对痴呆症的准确流行病学估计。 方法强心脏研究是一项以 11 个美洲印第安部落为基础的队列，在相隔约 7 年的两次访问中进行了详细的认知测试和检查。专家小组审查了认知状态（完整；轻度认知障碍 [MCI]；痴呆；其他受损/非 MCI）和可能病因（阿尔茨海默氏病 [AD]、血管性脑损伤 [VBI]、创伤性脑损伤）共识裁决的案例材料[TBI]，其他）。结果 70-95 岁的美洲印第安人有 54% 的认知障碍，其中 10% 患有痴呆症。 VBI 和 AD 是主要病因，比例大致相等 (>40%)。载脂蛋白 (APO) Eε4 携带者在痴呆症患者中更为常见 (p = 0.040)。认知障碍患者的血浆 pTau、胶质纤维酸性蛋白 (GFAP) 和神经丝轻链 (NfL) 较高，但β淀粉样蛋白 (Aβ) 则不然。认知完整度平均为 3MSE 92.2 (SD 6.4)，蒙特利尔认知评估 (MoCA) 平均得分为 21.3 (SD 3.2)。 讨论 这是第一项基于人群的研究，旨在估计血管性痴呆和阿尔茨海默氏痴呆的患病率。美洲印第安人。亮点强心脏研究是一项以美洲印第安部落人口为基础的队列研究，在美国三个地理区域（北部平原、南部平原、西南部）进行了 30 多年。我们的团队在相隔约 7 年的两次访问中进行了详细的认知测试、神经学检查和脑成像。 专家小组审查了收集的材料，用于基于共识的认知状态判定（完整；MCI；痴呆；其他受损/非 MCI）和可能的潜在病因（AD；VBI；TBI；其他）。在这组 70-95 岁的美国印第安人中，54% 的人被判定患有认知障碍，其中约 35% 的人患有 MCI，10% 的人患有痴呆症。这些数据扩展了之前使用电子健康记录进行的研究报告，这些研究表明美洲印第安人的痴呆症患病率和发病率与大多数人口或非西班牙裔白人更具可比性，这可能是由于临床环境中潜在病例计数不足所致。血管和神经退行性损伤对认知障碍的影响大致相同，这表明一级预防需要减少心血管疾病。创伤性损伤比其他人群更为普遍，并且在“其他/非 MCI”认知障碍类别的人群中很常见。与其他人群相比，常见痴呆症筛查工具的平均分（即使是那些被判定为未受损的人）也相对较低（平均未受损 3MSE 92.2，SD 6.4；平均未受损 MoCA 21.3，SD 3.2），这表明需要对常见痴呆症筛查工具进行文化和环境适应。筛选和评估工具。